Claims Specialist

Summary The claim specialist verifies the accuracy of and completeness of patient’s account within the dental practice, ensuring compliance with billing standards and identifying potential errors and fraud prior to the claim being billed to the insurance company.

Pay Range $22.00-$24.00.hour (Based on experience)

This is a full time hybrid position to work 1 day a week in the Bakersfield or Fresno Children's Choice Dental Care office and work remotely 4 days a week. The work hours will be 10am-7pm or 11am-8pm PST and 2 Saturdays a month.

CHOICE Healthcare Services is the largest provider of pediatric dental care in the Southwest United States, and we pride ourselves on delivering high quality care to children in our communities. Every day, thousands of people trust us to provide their families with healthy, radiant smiles.

What we provide to you as a CHOICE teammate

• Care for your wellbeing and work-life balance
• Professional and personal growth
• Experienced leadership support
• Fun and supportive team dynamic with events and celebrations
• Comprehensive benefit package
  
  
  

Essential Duties and Responsibilities include the following. Other duties may be assigned.

• Verify insurance coverage and benefits are correct.
• Monitor healthcare documents to ensure compliance before submitting to insurance companies
• Check medical records for appropriate criteria and provide the proper documentation
• Collaborate with providers to ensure all information is accurate
• Review requests for services, research and gather further information, when necessary, perform an information audit, and evaluate procedures for approval
• Record, analyze, and report data elements that could help improve the quality of care of a patient.
• Review treatment plan and chart notes.
• Pre-Auditing charts
• Post Auditing charts
• Respond via teams' chat/ email to OPs team & RCM Billing team in a timely manner
• Ensure billing errors are flagged and corrected
• Create claims
  
  
  

Education and/or Experience and Qualifications

• Associate degree (A.A.) or equivalent from two-year college or technical school; or six months to oneyear related experience and/or training; or equivalent combination of education and experience, preferred.
• Minimum of high school diploma or equivalent.
  
  
  

Experience

• Customer service experience.
• Strong MediCal Dental background
• Preferred six months previous experience in a health care facility or role to include direct patient contact or previous customer service experience.
• Dental healthcare experience in a dental office setting.
• Systems- Microsoft Excel, Word, Outlook, Teams, OneNote, Open Dental, NICE, NexHealth